“I have pelvic pain, pain with intercourse, menstrual cramps (pain with period), and infertility.  A friend said I might have endometriosis.  What is endometriosis?  How do I know if I have endometriosis?  What are my choices for endometriosis treatment? A.C.”

What is endometriosis? The tissue that normally lines the inside of the uterus is called the endometrium. If this type of tissue grows outside of the uterus, the condition is called endometriosis. The most common areas for the growth of this endometrium-like tissue are the reproductive organs (ovaries, fallopian tubes, uterus) and the peritoneum (the thin, Saran Wrap™-like lining of the abdominal cavity).  Endometriosis may also grow on the intestines or bladder and rarely in distant sites.   This misplaced tissue (endometriosis) can respond to the hormones of the menstrual cycle and can bleed each month in the same way the lining of the uterus responds to hormones. This can cause irritation of the lining of the abdomen with resulting pain. For more detailed information about endometriosis, please go to my website www.endometriosistherapy.com.
What causes Endometriosis?The cause of endometriosis is uncertain. There are several theories, but none of them explains all cases. Sampson’s theory suggests that menstrual flow backwards into the fallopian tubes and abdomen allows attachment and growth of endometrial tissue. Another theory notes the presence or absence of certain chemicals that may stimulate the growth of endometriosis from multi-potential cells (cells in the body that can become many different types of tissue). Another theory holds that endometrial tissue may travel to areas outside the uterus through blood vessels or the lymph system. How do I know if I have endometriosis?Some women with endometriosis have no symptoms at all.  More common symptoms may include:

• heavy menstrual flow
• pain in the pelvis or low back before or during the menstrual period
• severe menstrual cramps
• pain on deep penetration with sex
• pain during bowel movements, sometimes with diarrhea during menses
• burning on urination often during the menstrual cycle
• infertility (difficulty becoming pregnant)

If I have pain or infertility, how do I know the cause is endometriosis? A suspicion that you may have endometriosis is based on history and physical exam.   Unfortunately, ultrasound, CT, or MRI cannot diagnose endometriosis.  The only way to diagnose and to determine the amount of endometriosis is with laparoscopy. This is an outpatient surgical procedure done under general anesthesia.  How is it treated? Endometriosis cannot be cured, but removing the tissue can do away with the pain and improve fertility.   Endometriosis can be removed at laparoscopy. If you have severe midline menstrual cramps, you may benefit from a presacral neurectomy.   Medications have limited success in treating endometriosis. For more detailed information about endometriosis, please go to my website www.endometriosistherapy.com.